Kalaivanan M K Kheng Soo Ng Kalai Amuthan G Losheni P



Pulmonary embolism (PE) is among the most common causes of maternal death during pregnancy and postpartum worldwide .The clinical diagnosis of PE in normal population is usually difficult, but it is more complicated in pregnant patients, because physiologic changes of pregnancy can masks signs and symptoms of pulmonary embolism.


In this case study, a Nigerian lady developed massive pulmonary embolism after sustaining closed left lateral malleolus fracture. She underwent plating of left lateral malleolus. After discharged from the ward she developed shortness of breath, palpitation and chest pain. Patient was brought in by ambulance team and noted SPO2 on arrival was 85% on room air, tachycardic 150 beats per minute. ECG: Sinus tachycardia with S1Q3T3. CT angiogram findings were bilateral pulmonary artery thromboembolisms. She was then given IVI Heparin in Emergency Department. Patient was then admitted in CCU and was given IV Streptokinase. Patient underwent thrombolectomy as well. Inevitably, patient passed away the next day after the operation. 


Pulmonary embolism in pregnancy is not uncommon and causes significant morbidity and mortality amongst pregnant women. Diagnosing PE can be challenging and involves the usage of echocardiography, laboratory, and clinical findings. Rapid and accurate diagnosis is vital because treatment must be initiated early before deterioration. However the treatment itself has potential complications. Most patients with DVT and/or PE can be safely and successfully treated with unfractionated or low-molecular-weight heparin for the duration of the pregnancy. But, in massive PE, thrombolytic or thrombolectomy must be decided fast to achieve a good outcome. 


Supplementary Issue